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THE RENTAL CAR’S GPS steered him in the right direction again, and he managed to be only eight minutes late to the Washington residence. He apologized but made no excuses. Whenever possible, he was scrupulously honest with people he interviewed, hoping to elicit the same from them. Excuses undercut that trust.
“Would you give me a tour of your home?” he asked.
Ms. Washington was a good housekeeper. The furniture was old but sturdy and clean, some with slipcovers, a few with antimacassars.
She led him to the kitchen and offered to put on coffee for him. He thanked her but said no to that and to water and soda. The kitchen smelled of something spicy. “You eat a lot of chicken?”
“Of course. Doesn’t everyone?”
“You’re right about that,” he said. He sensed that he had better not insult her cooking practices, but he hoped she knew how to handle it and cook it through. “No pets?”
A little girl walked in, about eight years old. She was sniffling.
Ms. Washington said, “Jasmin, you supposed to be in bed.” She pronounced it Jazz-meen, emphasis on the second syllable.
“I’m bored.”
He squatted down. “Hi, Jasmin. I’m Dr. Stevens. How are you?”
She looked squarely at him. Her eyes were red around the rims. “You going to give me a shot?”
“No. All I do is ask people questions. Maybe listen a little bit when they breathe.”
“Stethoscope. S-t-e-t-h-o-s-c-o-p-e.”
“Wow, that’s right.” He didn’t have to fake being impressed. That seemed very advanced for her age.
“I won the spelling bee this year.”
“Congratulations! What word did you win on?”
“Jesus messed up on ‘Wednesday.’ He forgot to say ‘capital W’ is all. Then I had ‘neighbor,’ which is easy. All the words are easy.”
Ms. Washington said, “Pride goeth before a fall. And you goeth back to bed, right now.”
“Can I come in and listen to your chest?” Glenn said.
“Is it cold? Your stethoscope?”
“I’ll only press it over your pajama top, I promise.”
The three of them trooped back to a bright yellow bedroom, hardly bigger than a walk-in closet in his house, but all the girl’s. She climbed into a single bed and lay straight, all business.
He said, “Do you have any pets, Jasmin?”
“We had a dog, but he died.”
“I’m sorry. It’s always tough when a pet dies.”
“I cried, but I’m okay now. It was last summer. There’s a picture of him on the shelf.” She pointed.
He looked. “He was as big as you. But you never had a parakeet or pig, did you?”
She snorted. “People don’t have pigs as pets. Only on farms.”
He smiled at her. “Now, let’s be quiet for a second so I can listen to you breathe.”
He checked her breathing and then studied her eyes. “Do your eyes itch?”
Her eyes narrowed in suspicion. “How’d you know?”
“Lucky guess?” He smiled at her again. He liked her. Smart kid. He had borrowed the O2 monitor from the hospital—stolen it, if he didn’t remember to return it—and checked her O2 level. 88, which he again did not like. He showed it to her.
“What is that?”
“It shows your oxygen saturation level, what’s happening inside your blood. Do you ever get graded on a spelling test, like 99 out of 100?”
“Yes.”
“That’s like this. This is 88 out of 100.”
“That’s only a B.”
Indeed it was. “It’s very much like that. People with less than sixty flunk.” Meaning they died, but he didn’t share that with her.
“How do I get an A?”
“Do what your grandmother tells you. Stay in bed, drink a lot of water and soda and soup. Most people, doing that, they’ll get better in a week. That’s how you get the A on this test.”
They left the little girl in her room and went back into the living room, where he quizzed both Ms. Washington and her sister, Mrs. Shaw, a widow of 64, diabetic and with diabetic retinopathy. Both were feeling poorly, with slightly elevated temperatures, but both denied feeling as sick as Will had been. Mrs. Shaw had an appointment at her doctor for Wednesday. They were both churchgoers, so he asked about church, if there had been more coughing there than usual. Neither recalled that there had been.
The son, Will, was the first case in the family. This 100% infection of his intimates was cause for worry but not panic. If everyone he’d come into contact with was sick, people he passed on the street, clerks at stores he’d shopped at, and coworkers, Glenn’s concern would increase. Will did not attend church, which Ms. Washington obviously disapproved of, but which Glenn knew was good news for the other members of the church.
He told them at what point they should go to the hospital—fever over 103 or breathing difficulties. Mrs. Shaw was on disability and was covered under Medicaid, so she was in the best financial shape for healthcare. Ms. Washington worked part-time and had no health insurance at all, not even the sad Obamacare policy Grace had. Jasmin was on Medicaid, as a child having slightly better access to healthcare.
“Her father probably dead, and her mama is in jail for six months for bad check trouble.” Ms. Washington sounded ashamed, as if it were her crime to not prevent her daughter from going down such a road.
“Jasmin is a delight,” he said. “I’m so glad I was able to meet her.”
She looked suspiciously at him, but it was clear when she decided he wasn’t having her on. “She’s a treasure.”
“Don’t hesitate to take her to the hospital if she gets much sicker.” That reminded him. “Have they called you about Will?”
She looked afraid. “No. He isn’t dead, is he?”
“No, no. But he has taken a turn for the worse with his breathing when I left there.”
She got up and walked into the kitchen to make a phone call. He could hear her coughing. When she came back, she said, “It’s too late to go there now. Visiting hours are almost done.”
He glanced at his cell phone to get the time. “It is late.”
“I’ll go first thing in the morning.”
“Take care of yourself. Please don’t overdo it. I can see you work hard here, but don’t take care of everyone else and let your own health suffer, okay?”
“You want me to call in the maid?”
He knew she was being sarcastic but answered the question. “Well, no. Nor the ladies from church, in case you spread this to them. If you get so sick you can’t take care of yourself or Jasmin, go to the emergency room, okay?”
“You think that’s going to happen?”
“I hope not. But Will is a young man and he’s quite ill.”
“And I’m an old lady, is that right?”
He was worried she was really offended until he saw the smile at the corner of her mouth. He smiled. “You have plenty of good years in you. But flu tends to hit older and younger people the hardest, and with flu, fifty is the age that becomes dangerous. Keep a good eye on Jasmin.”
“I always do.”
“I know—I can tell that you do. Thank you for your time and all the information.”
He drove to his hotel and checked in and then spent some time on his computer again. First thing, he ordered his own O2 monitor with overnight delivery from Amazon, and a thermometer. He owned several, but he had a bad habit of misplacing them. Next was mail. He had received an email about who was assigned to him from EIS and sent them both an email suggesting they have the basic supplies to examine people. You never knew when getting an O2 sat out in the field might let you send someone to the hospital just in time to save them.
He listened to his voicemails and stuck most of them into a holding pattern that he was afraid he wouldn’t be able to clear out for a week or two.
As he lay down in the hotel bed, his mind was filled with an animation of how a virus invades a cell, hijacks it, uses it to replicate itself, and burrows out. All over Trenton, he feared, that was happening in the mouth and esophagus and lungs of many people—many more than the two dozen he knew about.
One of his mentors, who had been prone to never getting popular culture terms exactly right, had called this sort of feeling his “spidosense.” Glenn’s spidosense had him thinking that maybe this was going to be worse—much worse—than it looked right now.
––––––––
THE TELEPHONE WOKE him. But it wasn’t his cell phone, which he groped for first. He registered the time on it, 5:41, and leaned over to answer the room phone. Must remember to disinfect that.
“Yeah. Stevens,” he said.
“Dr. Stevens, it’s Joan, Nurse Ellis. Mr. Washington is crashing. It doesn’t look good.”
“You called the family?” he said. “I’m on my way.”
He washed his hands and face, applied deodorant, said to hell with shaving, and threw on his second set of clothes, rather wrinkled from weeks in the suitcase, but they’d have to do.
He checked phone messages on the elevator.
A voice called his name.
He turned to see the elevator door was open and Roy Gillens was walking his way. Glenn said, “Good to see you. And just in case, I’m not going to shake your hand.”
“I could kiss ya on the cheek instead,” Gillens suggested with a grin. He was an outgoing charmer, and somehow lines like that didn’t seem to bother anyone—including Glenn.
“I’ll forgo that pleasure,” Glenn said. A young woman was walking up to him. She extended her hand, and said, “Harper Bail, Dr. Stevens. I’m new.”
She looked it. Freshly scrubbed, so young-looking he had to push down an urge to ask her for ID, tall, and quite pretty. No sexual urge came with the thought, for she was young enough it would be like robbing the cradle for him. “Sorry about no handshakes,” he said. “I don’t want to pass along anything I might have caught in the hospital. And call me Glenn.”
“I’m Harper, then. I just joined EIS three weeks ago.”
“First one, eh?”
“Yes, sir.”
Roy said, “Sir? And he’s not even wearing his uniform.”
The new girl—woman—didn’t ask what uniform, so at least she knew something about how things worked.
As an officer in the U.S. Public Health Service, Glenn only needed to wear his uniform to official functions. The USPHS was one of the seven uniformed services of the U.S.A., but the least well known and, like NOAA, it was full of scientists rather than military careerists. Glenn barely knew which end of a gun was which, and he wasn’t the only one who had to read up on uniform regulations every time he was required to don his. In his mind, he was an epidemiologist first, a CDC scientist second, and a USHPS officer third.
He glanced down at the wheeled suitcase Harper was towing and said, “Didn’t get a room yet?”
“No, we have rooms. This is everything I thought I might need in the field. Laptop, forms, camera, plus what you said to bring.”
“Great. You don’t speak Spanish, do you?”
“No, sorry. German and a little Dutch.”
“MD, microbiologist, or...?” he asked her.
“Med school but never did a residency. My Ph.D. is in Toxicology and Environmental Health.”
“Maryland?” he said.
“Yes, sir.” She smiled and shook her head at herself. “Uh-huh.”
“You a whiz at statistics?”
“Passably good,” she said.
“Oh, bull,” he said. “I’m betting you’re a whiz. Okay, here’s how this is going to—no, wait. Shit.” He wanted to be in three places at once. “Roy, you run right over there and charm a conference room out of the hotel clerk, would you? Tell them we’ll want more space later on.”
“How much more and when?”
“Whatever rooms they have. Uh, one decent-sized room now and indefinitely, and if they have something going on this weekend, have them pencil us in for Monday for whatever else is open then.”
“Sure. I’ll have them put it on your tab.” He went to the desk.
“Okay, Harper. Here’s how we’ll do this. You map, liaise with public health, funeral homes, keep stats. Okay?”
She nodded as she took out a tablet computer and jotted down notes.
“I assume stats and mapping will be like falling off a log for you. I have a meeting with the Director of Public Health for the county of, uh...”
“Union.”
“Right. Not awake yet, sorry. Union County, New Jersey. Anyway, meeting tonight at 6:30. You’ll be there, and I’ll introduce you.” He glanced at Roy, who was laughing with the hotel clerk. “Roy will be clinic and hospital liaison, and you’re both going to be interviewing cases whenever it comes up. For Roy, there’s a second hospital I didn’t even get to yesterday, so that’s the priority for him. Four admits by yesterday evening there, I’ve heard, but it could be more by now. In interviews, you’ll check out movements, contacts, exposures, try to trace back to the vector. I know you know that—just reminding you. I’ll do patient interviews when I can.
“Harper, here’s something to remember for the future. I hate losing touch with the disease and what it’s doing to people. But when you’re running an investigation with several staff, that happens. So you know this for the future, I’m telling you. It’s good to remember the people suffering out there, and to get your eyes on the sick people from time to time. For one thing, it reminds you what the priority is, but also, as you gain experience, you might see something a newer investigator would miss. Got it?”
“Got it.”
Enough mentoring for now. “You each have your own cars?”
“Yes.”
“We’ll all start together at the hospital I was at yesterday. I want you to both see the two patients there I interviewed yesterday, and introduce you to anyone I can, and Roy needs to get to the other hospital after that.” He yawned. “I need coffee. Did you two get any sleep?”
Harper said, “Roy was asleep on the plane. I was studying.” She blushed as soon as she said it. “I need to catch up on reading, I meant, so I couldn’t sleep.”
“Try to get a solid six hours or more every night from now on. And you’ll take Sunday off too. Roy will take Saturdays off. Don’t forget that. I might, so remind me.”
Roy was coming back, jingling a ring of old-fashioned keys, not electronic ones. “We have two conference rooms, one big, one small, and a third one starting on Monday.”
“How far are we from the holiday weekend?” Memorial Day was coming up.
“Still three weeks away,” Harper said.
He gave them the name of the hospital where Will Washington had been, watched while they plugged the info into their phone and tablet, and said he’d meet them inside the main entrance in a half-hour. “I need to hit a drive-through first. Don’t forget to eat, Harper. It’s easy to do.”
When he got to the hospital, the receptionist was talking to Harper and Roy. Roy said, “Here he is now.”
“Dr. Stevens? Ms. Ellis wanted me to tell you to take one of the visiting doctors’ parking spaces. The area is marked clearly. It’s right against the south wall of the main building. Here, keep this displayed.” She handed him a tag to hang on the rearview mirror. “And here’s the code.” She handed him a sealed envelope. “That will get you past the automatic gate to the staff lot.”
“Thank you.”
“Will your colleagues need something similar?”
He didn’t even need it, though it was a nice gesture on Ellis’s part. “Maybe in a couple days.”
Roy grumbled good-naturedly about that in the elevator up to the ICU. “Boss gets all the perks.” But when Glenn offered him the parking tag and envelope, he shook his head. “I’ll need the exercise of walking across the parking lot.”
When they arrived at the unit Mr. Washington was on, they walked into an empty room. An orderly or aide was cleaning up. “Did we lose him?”
“At 6:02.”
Glenn glanced at his watch. “I need—damn. I’m sorry.” He noticed the woman cleaning up was gloved but not wearing anything over her face. He debated ten seconds before saying, “I think maybe you should have a mask on. And double-glove too. Be super-careful about sharps, right?”
She looked at him wide-eyed. “Is it bad? Not Ebola or something?”
Everybody was so anxious to jump right to Ebola. “Definitely not Ebola. Probably flu. Until we know more about it, I want you to be cautious, okay?”
The three of them backed into the waiting room. “You two find a patient named Grace—damn, what was her last name? Grace....” He had to check his notes, which he’d kept a copy of on his phone. “White. No, Roy, you do that, and find her, introduce yourself and text me the room number. We’ll be there in a minute. Harper, you’re with me.”
He took her to the elevator and punched the lowest level.
“Morgue?” she said.
“Yeah, to caution them about protocols.”
“We don’t have any protocols set on this one, do we?”
“No. Not officially. We don’t even know with certainty what it is.”
“You said flu. They did rapid response tests here?”
“Yes, but you know it won’t be 100% confirmed with only that. I think it’s a flu, but it could be something else.” He presented the first fatal case to her. “We have an otherwise healthy African-American male of 32. He lives with his mother, who is by all appearances a careful cook and housekeeper. I’d rather have a meal there than eat at a restaurant, when it comes to risk of disease. They have no pets. No international travel. All of his intimates—family and the girlfriend Grace—are in the early stages, with the girlfriend the most advanced. He did not mention to family or doctors that he had come into contact with an obviously sick person, but I never had a chance to interview him. His hobbies according to his mother are watching sports and dancing—nothing exotic, and nothing that involves animals. He presented at his primary care physician with fever, cough, inflamed throat five—no, six days ago. He was admitted to the hospital Sunday with difficulty breathing. X-rays showed fluid in his lungs. No unusual bleeding. No digestive issues. Today is Tuesday, and he’s dead. What do you think?”
“I think I’d wait for the lab before trying to pinpoint it.”
“Wise. But if you had to guess.”
“I’d rather test than guess, but influenza seems right.” She shrugged. “Could be a lot of things. Is he HIV-positive?”
“No. No hep, either. Perfectly healthy young man. He was, at least. God, what a waste.” The elevator doors opened. He hit the open door button and held it while he quizzed her. “Cases of hantavirus this year in the U.S so far?”
“Twenty, I think. About ten deaths a year on average.”
“SARS?”
“None.”
“MERS?”
“None. Two total, a few years back—a healthcare worker who had been to Saudi Arabia and a contact of his, I believe.”
“Mr. Washington worked at a gas station and was not a healthcare worker.”
He left the elevator and spied the “Morgue” sign. “There it is.” He stopped again outside the morgue door. “It’s hard to get the general populace excited about the flu, but healthcare workers should know better. Another quiz. When will we know for sure? I got swabs off to Atlanta about five-thirty last night.”
“Assuming it arrived before nine this morning? The enzyme-linked immunoabsorbent should have it today, by noon if they are prioritizing it. The RNA profile, three days. So if it’s a new strain, Thursday evening? Maybe Friday morning.”
“I hope. I want to know that. Whatever it is, it killed a healthy young man.”
Inside the morgue, he found the man in charge, an elderly black man, and cautioned him to use strictest protocols with Mr. Washington. “The autopsy is conducted where?”
“Here, unless I get paperwork that says otherwise.”
“You’re the pathologist?”
“No, sir, I just work here. Dr. Echiverra will likely do it.”
“Is she or he good?”
“She. I assume so. We sure don’t get any complaints.”
“Morgue humor. Gotta love it,” Glenn said. “Thank you.” He cautioned the man again to treat the body with maximum precautions, and then they left the morgue.
Waiting for the elevator, he pulled out his phone and scrolled up the to-do list. “I’m making a note to ask Ellis—she’s an MSN, head of infection control here, and very good—about their pathologist. I think she’ll tell me true.”
“I see,” Harper said.
“Make friends with the locals, right? You ever assigned to Africa yet? Other developing nations?”
“I’m brand new.”
“Right. Fresh out of academia, I remember. I was thinking maybe you’d gone during your graduate studies. Anyway, it’s the same there as here. If people are religious, respect it and make friends with the medicine man or priest or imam. If there’s a head man or hospital administrator, connect with him and show him respect. Or her. I find it easiest to discover one person I actually do respect, and then I don’t have to fake it. Cooperation and fellowship gets you further, faster than just ordering people around. But then, don’t hesitate for a second to order people around if it’ll save lives.” The elevator door opened. They were alone. “Personal question, if you don’t mind?”
“Go on.” She looked cautious.
“You didn’t go on to practice medicine because...?”
“I didn’t like whining.”
“It wasn’t blood, or vomit, or despair at not being able to save them.”
“No. I discovered I don’t have any patience with whiny people. And when people are sick, they whine. I understand that, and I’m probably no different. But understanding it did not bring any...love to my heart, I suppose is a good way to put it. I still hate whining.”
“Thank you for your honesty. So if I ask you to step in to the autopsy to take a gander at the organs, you’re fine with that?”
“I am, totally. But I don’t know what I would see that an experienced pathologist would miss.”
“Possibly nothing. But you have to build up your own reference library of real-life cases. What you’ve seen with your own eyes, right? Though for pity’s sake, respirator, gown, face shield in the autopsy. Maximum precautions.”
“Yes, sir.”
“You’re doing it again.”
She frowned, not understanding.
“Sir-ing me.”
“When you talk like that, it’s hard not to.” She had a hint of a smile.
“Point taken.” He checked his phone. No new text. “Call Roy, would you? See where we’re going.” The door opened at the lobby and there were people waiting to get on. The crowded elevator was making him nervous—not for himself in particular, but for everyone. If there was a contagion spreading, elevators and airplanes were places you did not want to be.
A few minutes later, the three of them were crowded into the space next to Grace’s bed. “Wow. I must be sicker than I thought,” she said. “Three of you.”
“How are you feeling today?” He realized she might not know yet that her boyfriend Will was dead, and wished he’d mentioned to Harper not to say anything.
“Hurts.”
“Where?”
“Lots of places, but since last night, my chest. I feel like a fat old cat I had as a kid is sitting there. Or the ghost of him.”
“Do you mind if I listen?”
“Go on. I’m not used to an audience though.”
“No need to move. I’ll listen through your gown.” She was in a standard-issue hospital gown, well-worn cotton with faded blue flowers. “Let’s have you sit up though. Lean forward. Breathe deep.” He heard crackles. “Count for me, from one to ten.” Today he could tell by how the words sounded that her lungs were filling with fluid. He didn’t need the X-ray to confirm it.
“How am I?”
“Sick,” he said. “But I bet you knew that. Has your doctor been in this morning?”
“Not yet. But a nurse left something for you. She knew you’d be in here, I guess. It’s over there, in an envelope on the window ledge.”
“We need your bed to stay upright. In fact, if you can sleep sitting halfway up, you’ll be more comfortable.” He knew he was stepping onto the toes of her primary care physician here, but if that doctor was here, he or she’d be giving the same advice. “Thanks, Roy,” he said, as Roy found the control and tilted the bed up.
Glenn went to retrieve the envelope. It held interview notes from Joan Ellis on Grace’s movements, contacts, and possible exposure.
“Thanks for remembering this. You take care of yourself, Grace.”
“I’m worried about what this is costing me.”
“Whatever it is, you’re definitely worth it,” he said. “Do what the nurses tell you.” He led his assistants out and down to the elevator, scanning through Ellis’s notes before handing them to Roy.
“So?” Roy said, once a staff person had gotten off the elevator and they were alone.
“She’s about twenty-four hours from needing intubation, I think. This is not good. Not a bit good. I’m going to call back and make sure they’re rushing those tests back in Atlanta.”
Harper said, “It’s not quite eight yet. They aren’t open.”
“Oh, right.” There was a night receptionist always on duty, but that wouldn’t do him any good.
“You need to wash up,” Harper said. “You touched her. Roy and I were well back, but Roy touched the bed controls so he should wash too.”
“Yeah. You’re right.”
When they got off the elevator, she pointed to a public restroom. Roy went first while Glenn took a minute to explain to Harper what to do next.
When Roy was back, Glenn said, “Roy, sometime today, on your way to the other hospital, make a shopping run. We want to all have gloves, masks, and plenty of each. Try to get the patients you interview to wear the masks, but if they refuse, you wear them, and don’t tell me it’s unlikely to work, because it’s better than nothing. I’ll order respirators in case we need them. And both of you, wash your hands a lot. I don’t want you two contracting this. Okay, you both have a game plan for the morning? Good. Let’s set a tentative lunch meeting for one o’clock. If we can’t do it in person, we’ll do a conference call. You both are on Skype, right?”
They nodded, and Harper left.
In the bathroom, Glenn washed up but then saw there was no automatic door opener to punch with his elbow. So much for not spreading germs. The hospital was probably twenty-five years old, and while certain equipment had been upgraded, other systems were probably original to the building. They had replaced hand towels with air dryers, but that meant there was nothing to touch the door with but his bare hand, which he’d just washed. So he waited for someone to come in and caught the door with his hip before it closed.
He wanted to talk to Ellis and thank her for her help so far, but it could be done by phone. First thing, he’d run back to the hotel and get the incident command center set up. When he had an interesting case to play detective with, like this one, he wanted to be out there on the streets, knocking on doors, doing interviews, finding the vector and transmission rate and everything else all by himself. But the more senior he had become, the less likely that was to happen. In Peter Principle fashion, his job now would become more and more administrative. His work would include tasks like setting up the conference room. And making phone calls. Reading reports from the Roys and Harpers who were doing interesting work. That it was the inevitable progression of a career in the CDC did not make him like it, and the extra pay was not at all sufficient compensation for being stuck in the office. He liked the disease-detective work, but he feared he was at the end of that part of his professional life.
By ten, he had the conference room beginning to take shape. There were white boards, projection equipment for computer presentations, a screen, all the hotel’s. He had also phoned companies that rented more office equipment he thought he might need to check its availability. He had checked with the hotel about use of a dedicated land line if things got busy, and they assured him that could be taken care of. He had phoned two local universities with MPH programs and left voicemails with the department chairs about the possibility of using a student to staff the conference room full-time and take some of the admin load off. It was the end of term, he assumed, and some go-getter of a student would jump at this chance for an unplanned internship. He wanted someone who was super-organized and could take messages accurately, even messages with technical details. As he knew neither department chair, he avoided using the term “anally retentive,” but that’s what he wanted—a pathologically organized person who knew something about the topic.
What else? He realized he hadn’t updated Emile. He phoned Atlanta and asked Emile to connect Chanchal in.
“I can do better than that. She just left my office. Let me grab her.”
Glenn heard him calling her name. Then, “Okay, she’s here and you’re going on speaker.”
“We’ve had our first fatality. Check that. First known fatality. Harper will know in a day or two if there are any other possibles among recent deaths.” He gave the patient summary for Will Washington again.
“Damn,” Chanchal said. “And the other patients?”
“I never got to the second hospital and I’ve only interviewed the family of that man and two others. Roy is on the other hospital right now. We’re meeting at 1:00, so depending on how quickly Harper can get information from clinics and comb through the death records, I might have quite a bit more to tell you by 1:30, and definitely I will by tonight. We have first lab results yet?”
“Within the hour,” Chanchal said. “I’ll e-mail it and mark it urgent.”
“You know patient zero?” Emile asked.
“Not a clue, but in this little cluster, it’s the man who just died. Two of his housemates are elderly and the other a child, all showing symptoms. Also, his girlfriend has been admitted to the hospital. Late twenties, healthy until now, same demographic. And her lungs are filling fast.”
“That’s bad,” said Emile. “Keep tabs on that family, would you?”
“I will.”
“I’m sure you’ve established a rapport.”
“Worse. I actually like them,” he said.
There was a moment of silence at that. When things got moving fast on an outbreak, the deaths became an overload of statistics, but in a small cluster, or at the beginning of an epidemic, the human face of the disease was all too clear. Anyone who thought it didn’t hurt public health officials to see people die didn’t know them very well. Glenn had been with Emile in Africa once, more than a decade ago, when he saw the man sit down outside a hut of dying people and sob. That half the people who died in such a situation were the healthcare workers you’d been working side by side with made it even harder to bear. But the Washingtons were obviously good people, and he hated to see good people die. Pathogens, though, didn’t give a crap about human character; they infected everyone, the good and bad alike.
Chanchal said, “Any healthcare workers yet?”
“Not yet, but it’s no doubt coming.”
“Droplets or aerosolized?” Emile’s question was about how it was transmitted.
“Probably only droplets, but don’t quote me.”
“Hint of vector other than human? Is there an animal host in North America?”
“No idea. Confirm flu and give me the type first, and I’ll know better where to look.” It would be far easier to narrow down a search for where the virus was coming from when they knew which disease it was. If it was the flu, either it was a common type that was always in the human population, or possibly the flu was in an animal population and had jumped to humans. Birds, cats, dogs, horses, sea lions, pigs, and other animals might carry it, not get sick themselves, and pass it to humans. But until he knew which flu, he wouldn’t know where that flu had historically resided. If it wasn’t influenza, that opened up a lot more possibilities. “We’re not on the coast, but there are seagulls.” He’d seen one on a sidewalk, pecking at crumbs.
“Okay, so we’ll let you go. I know you’re busy. And doing what you can.”
“I’ll phone again after I meet with the Gillens and the kid.”
Emile said, “Yeah, I sent you a green one, didn’t I?”
“She’s sharp, though. Answered every test question I threw at her. I think she’ll do well.”
“We try not to hire the dimmer applicants. How you made it through the hiring process, I’ll never know,” Emile said.
“Oh, screw you,” Glenn said, laughing. “Talk to you both later.”
He checked his to-do list and made two dozen phone calls. He had Ellis check to make sure Washington had been on antivirals before he died. He had—zanamivir. “I’d suggest Grace White be put on oseltamivir today,” he said. “Can you get me her physician’s number?”
“I happen to know her fairly well,” Ellis said. “The family doctor, I mean. We take a yoga class together. I can take care of it if you want.”
“Thanks. That would take a load off my mind.”
“Oh, and I almost forgot. Washington’s little girl was admitted an hour ago.”
“Damn it,” he said. “Niece, not daughter. Jasmin.”
“Shortness of breath,” she said. “I have the ER looking out for more cases and they’re calling me with each one. We’re up to over twenty admits now.”
“Have you met Roy Gillens yet?” He gave her Roy’s phone number. “He’s keeping stats on hospital visits and admissions, wandering around your place right now, I think, if he’s done with the other hospital.”
“How many cases so far there?”
“I don’t know yet. If you’d like, I’ll phone you at the end of the day to update you.”
“I would like that, if it’s not too much trouble. How about protocols?”
“The CDC will issue official protocols probably on Wednesday, once we’ve nailed the precise pathogen, with possible revisions on Thursday or Friday, or anytime thereafter, as we get to subtype.”
“What’s your best guess? For our protocols?”
He hesitated only a second. “If it were me, I’d have all staff that dealt with the patients indirectly, the cleaning staff, morgue, everyone like that, highest level of mask, double-glove, and revisit fitting masks and sharps procedure with them. Direct care? Honestly, I’d go with respirators.”
“NP95?”
“Yeah, I would. Only a hunch right now.”
“I’m sure your hunches are better than my careful calculations.”
“I’m sure that’s not so. You obviously know your field. But you also know what the rates of infection are of healthcare workers in viral outbreaks.”
“Thank you for being straight with me. I’ll get on it immediately.”
“Talk to you soon, and again, thanks for getting in contact with Grace White’s physician for me.”
One of the university department chairs called him back. “I have just the right person,” the fellow said. “Hang on and I’ll give her your phone number.”
Then that person called back not ten minutes later—a great sign—and he asked her to come in and talk with him late that afternoon. Then he went and asked the hotel desk clerk about places to order in food. Fifteen minutes later, the fellow brought in a stack of photocopied menus. “These two are carry-out but walkable, and the Thai place is great. These six deliver here.”
That was enough for now, he decided. All this other admin stuff, he’d push onto the student if she agreed to work with them.
A few minutes after noon, he called Roy and Harper to see if they could meet in person. No go, so they confirmed a Skype conference at 1:00. He spent the interim time emailing and writing reports for Atlanta.
Just before 1:00 he got a call from Chanchal. “It’s influenza A. H5N1.”
He was shocked. “Transmitting from person to person? In May?”
“So you say. I’d love for you to find out something else is true. Do your damnedest to find an avian vector. Maybe they all go to illegal cockfights.”
“The little girl certainly didn’t. Chanchal, it killed a healthy young man. Killed.”
“I know. We knew it was coming one day, didn’t we? HPAI that transmits from person to person.”
He hung up and felt a chill that had nothing to do with being sick. HPAI. Highly pathogenic avian influenza. Limited to small outbreaks in Asia and Egypt so far, it had a CFR—case fatality rate—of .61.
Six out of every ten people who got it would die.
